Abstract / Summary
Background: Integrating physical and mental health care can improve outcomes for people with mental disorders, yet its implementation remains challenging. Although implementation research has identified barriers and facilitators, less is known about how stakeholders understand integrated care during pre-implementation and how these understandings may influence implementation. Objectives: This study explored healthcare professionals' and service users’ understandings of integrated care during pre-implementation and examined contextual factors influencing its implementation within a local Brazilian Psychosocial Care Network. Methods: This exploratory-interpretive qualitative study was guided by the Consolidated Framework for Implementation Research (CFIR). Between September and November 2025, two focus groups with 13 healthcare professionals and 15 semi-structured individual interviews with service users were conducted in a municipality in São Paulo state, Brazil. Sample adequacy was guided by thematic saturation. Data were analyzed thematically by combining deductive CFIR-guided coding with inductive coding of context-specific emerging patterns. Results: Five themes emerged: interservice communication and information exchange; network organization and integration; stigma, professional training, and shared responsibility; care pathways, referral, and service navigation; and perceptions of integrated care. Fragmented communication, weak coordination across the care network, and limited interservice collaboration were identified as barriers, whereas matrix support, therapeutic relationships, continuing professional education, and interprofessional collaboration facilitated implementation. Healthcare professionals and service users also expressed differing understandings of integrated care, reflecting distinct expectations regarding its implementation. Conclusion: Pre-implementation analysis identified contextual determinants and differing stakeholder understandings that may shape the implementation of integrated physical and mental health care. Considering these perspectives when designing implementation strategies may enhance their acceptability, contextual fit, equity, and sustainability within community-based mental health care settings with similar organizational characteristics.